Insulin therapy in type 2 diabetes for physicians and practitioners

Area of Science:

• Endocrinology
• Pharmacology
• Metabolic Diseases

Background:

• Insulin therapy, introduced in the 1920s, is crucial for managing type 1 and type 2 diabetes.
• Despite widespread use, less than half of type 2 diabetes patients on insulin achieve the target HbA1c level of 7% or less, indicating common suboptimal therapy.

Purpose of the Study:

• To review the advancements in insulin therapy.
• To discuss various insulin regimens, including premixed insulin, basal-only, and basal-bolus strategies.
• To highlight factors influencing insulin regimen choice and patient compliance.

Main Methods:

• Literature review of insulin therapy advancements.
• Discussion of different insulin types, including insulin analogues.
• Explanation of insulin administration techniques (storage, mixing, timing, injection sites).

Main Results:

• Insulin analogues have been developed for optimized glycemic control.
• Premixed insulin can be safely used with oral hypoglycemic agents (OHAs).
• Insulin regimens (basal-only, premixed, basal-bolus) are described, with starting doses and the need for dose adjustments.
• Improved delivery devices enhance patient compliance and acceptance.

Conclusions:

• Insulin therapy has seen remarkable progress with analogues and better devices.
• Suboptimal glycemic control remains a challenge for many type 2 diabetes patients on insulin.
• Individualized insulin regimens, considering patient factors, are essential for effective diabetes management.